HomeMy WebLinkAbout0103523 HOSHKOSH
ON THE WATER
.lob Address 558 MONROE ST
Contractor BLACK-HAAK HEATING
Fuel
System
Gas J ~J Oil
CITY OF OSHKOSH
HVAC PERMIT - APPLICATION AND RECORD
Owner JACOB P MANGEN
Category 502- Residential-Both
L~ Electric
New ] ~] Replace ]
Forced Air ] ~ Radiant
Electric I ~J Hot Water
L~ Steam
L~ suppl.
Solar
A/C
Con. Burner
Chimney Type I~) Chimney A ~) Chimney B O Direct Vent ~ Not Applicable I
Heat Loss ]~ As Approved O Existing ~ Not Applicable ] Value
BTU Rate ]~ As Per Plan ~) Variable ~ Other ] Value
No
Create Date
Plan
~ Solid
103523
08/13/2003
Other ]
Vent
75m
Use/Nature DUPLEX/Replace one furnace and install one A/C.
of Work
Fees: Valuation
Issued By:
$2,500.00 Plan Approval $0.00 Permit Fee Paid
Permit Voided
$42.50
Date 08/14/2003
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature Date
Agent/Owner
Address PO BOX3070 APPLETON WI 54914 -3070 Telephone Number
(920) 757-9990
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
Division of Inspection Services
P.O. Box 1130 ~
Oshkosh, WI 54903-1130 ' ~ED
Phone (920) 236-5050
HVAC PERMIT APPLICATION CNa~ D£PARTEicA,
All information after bold categories must be provid~, flqgqUN/~, ff!/:NT OF
Incomplete applications will not be processed. ~ ~ L~EV~L~..-
rl gNT
· Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128,
Oshkosh WI 54903-1128. Cornmeneing work without permit(s) will result in fees being doubled or $100.00 plus the
normal permit fee, which ever is greater.
OR
If you are a contractor participating in the Permit fee Account System and have adequate funds, check here
if vou want this processed through ~our account [~
CttECK [] ALL APPLICABLE
USE CATEGORY
V1Single Family fl~uplex
ElMulti-Family V1Rental ElCommerCial Vllndustrial
FUEL ~,~as V1Electric FlSolid SYSTEM V1New ~]Replace
F1Oil VISolar FIOther
TYPE
J~orced Air F1Radiant USteam [~C UVent UElectrie
IS CI:llMNEY BEING LINED ~No glYes - LINER SIZE
Note: Ail chimneys shall be sized per the BTU's being vented.
V1Hot Water I~Suppl.
& MANUFACTURER
[2Con. Burner
CltIlVlNEY TYPE ~Chimney A ~Chimney B ~i~Direct Vent F1Oth~r
FIEAT LOSS F1As Approved J~Existing F1Not Applicable
BTU I;La, TE I-lAs Per Plan F1Variable ]~Other Value '~,~/~90
DESCRIPTION OF ALL WORlC BEING DONE ~*V C.,hq '-~ ~r~&Cd
VALUE (Including labor and all materials including light fixtures) $
ELECmC tCOm C O U'--<
[] For applicable prOJects, an Electric Installation Verification form, signed by the Electrical Contractor, must be
attached. If not attached or not applicable, a separate Electrical Permit is required.
9/02